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State of the states: health insurance exchanges - January 10, 2014

Over the winter break while we’ve been gone, CMS announced that since October 1, 2.1 million Americans had signed up for health coverage using HealthCare.gov and the State-based Marketplaces (SBMs), with roughly a little over one million using HealthCare.gov to sign up for insurance. The rush of new sign ups has created some problems for insurers as they prepare to effectuate enrollments for their new customers. While the number of errors in 834 transactions continue to decline according to industry reports, insurers and CMS are still working toward resolving differences and errors in their respective files as they write new policies. However, premiums have to be paid before the new policies can go into full effect. Most carriers in the Federally-facilitated Marketplace have been offering their new customers retroactive coverage to January 1, so long as their payments are received by the insurer’s deadline. Many new enrollees had until January 10 to pay their first month’s premium, but just this week, a few large insurers have announced another round of payment delays. WellPoint customers now have until January 15 to pay their first month’s premium, while Health Care Service Corp, which operates Blue Cross Blue Shield of Texas and Blue Cross Blue Shield of Illinois and a few other Blue Cross plans in other states, moved back their payment deadline to January 31. Some SBMs have recently announced deadline extensions for premium payment in recent weeks, with Covered California’s Monday announcement that customers had until January 15 to pay their January premium.

The last-minute scramble to verify information and payments for coverage retroactive to January 1 has the possibility of distracting new shoppers from their fast approaching deadline to purchase coverage beginning on February 1. Currently, the deadline to purchase insurance for February 1 coverage is next week on January 15. After that, customers that select a plan in January will need to wait until March 1 for their coverage to go into effect at the earliest.

Even with all the new activity on HealthCare.gov, federal officials still acknowledge that some persons might be having difficulty signing up for coverage. In an effort to help equip the frontline support staff of insurance agents, Navigators and Community Application Counselors that are assisting applicants on the ground, CMS posted a variety of fact sheets in late December and early January. The resources cover issues with eligibility and plan selection, the application process and eligibility issues that some non-citizens have faced. One of the guides also offers tips to help educate consumers on how they can verify that persons claiming to be federal call center agents asking for their personal information are in fact call center agents and not fraudsters.

CMS also posted a FAQ on December 30 to help SBMs better understand their responsibilities when filling out the State-based Marketplace Annual Reporting Tool (SMART). The SMART is an integrated annual reporting system that SBMs will use to demonstrate to CMS that they are adhering to CMS rules and regulations for Marketplace operations. The first SMART report from each SBM is due to CMS on April 1, 2015.

Speaking of the states, this week we saw some of the first board meetings for state-based marketplaces in 2014. However, most of the attention was focused on the SBMs that still continue to have lingering problems with their IT systems. Specifically, most of the developments centered around SBMs engaging firms to fix their IT issues and hiring outside examiners to conduct investigations to determine why some marketplaces experienced problems when they launched and how to prevent those mistakes in the future.

On the investigation end, Minnesota’s Legislative auditor kicked off an investigation into MNsure this week, though it could be a few weeks before audit staff begins an onsite examination of MNsure. Two other marketplaces, Cover Oregon and Vermont Health Connect, are in the early stages of launching investigations into their marketplace troubles. In Oregon, Governor John Kitzhaber announced that First Data Government Solutions has been hired to figure out when officials were aware Cover Oregon would not launch on time and how the operational scope of the project was determined. In Vermont, a firm has not been hired to conduct an investigation yet, but the Department of Vermont Health Access has already asked for proposals from four of the agency’s “preferred vendors.”

In terms of efforts to improve the operations of various marketplaces, MNsure announced this week that it has asked Optum/QSSI to review the online portion of its marketplace and make recommendations on fixes. MNsure is not paying Optum for its initial consultation, but as of Wednesday morning the firm had 15 staff on the ground in Minnesota, including some veterans from the firm’s repair effort on HealthCare.gov. MNsure expects to receive a preliminary report from Optum by the middle of next week.

The Massachusetts Health Connector, which has also experienced significant problems with the online portion of its marketplace, revealed plans to hire Dell to fix the marketplace’s ability to send 834 files to insurers and MITRE to perform an end-to-end review of the marketplace’s existing system and help determine next steps for technical fixes. That review will be completed for the exchange by January 17.

Finally, before we go, at this week’s board meeting for Cover Oregon, there were no obvious signs that the marketplace had decided to bring in outside consultants to help launch the marketplace’s end-to-end online enrollment system. So far, Cover Oregon continues to coordinate its development efforts with its main IT contractor, Oracle. However, even under repeated lines of questioning from board members, staff were careful to avoid stating any timelines for when the Cover Oregon portal would launch. One of the main hurdles for launching the online marketplace continues to be Cover Oregon’s system to perform remote identity proofing, which remains under development.